suPAR Monograph

On the basis of more than 500 published articles on suPAR in PubMed, a suPAR Monograph has been written. Here you can find a short summary of the research done on suPAR within 12 groups of disease areas and see how the suPAR level is affected within each kind of disease. The summary of each disease area is found under Applications here.

Key suPAR publications

December, 2018

“Combining National Early Warning Score With suPAR Improves Risk Prediction in Acute Medical Patients: A Registry-Based Cohort Study” published in Critical Care Medicine.

In this large study including more that 17.000 patients, Line JH Rasmussen and coworkers aimed to evaluate whether suPAR adds prognostic value to a vital sign-based score for clinical monitoring of patient risk (National Early Warning Score, NEWS) in acute medical patients.

High suPAR was associated with in-hospital-, 30-day-, and 90-day mortality within all NEWS Score groups, in particular in patients with a low NEWS. Combining suPAR with NEWS, age, and sex in prediction of 30-day mortality, gave an AUC of 0.90 with a negative predictive value of 99.0%.

In patients with normal vital signs and high suPAR, risk may not be clinically recognized and fewer actions taken. The authors conclude that using suPAR in combination with NEWS could potentially lead to clinical interventions among patients otherwise not considered urgent or at risk, thereby ultimately saving lives.

Finally, the high NPV found in this study may aid in hospital discharge decisions, and as anunspecific biomarker, the NPV may be of most clinical relevance in clinical decision-making.

May 21, 2018

“suPAR predicts mortality in exacerbated COPD” published in Respiratory Research.

The study by Nina Godtfredsen and coworkers hypothesized that increased suPAR is an independent predictor of short-term mortality in patients admitted to hospital with COPD or acute respiratory failure. The study included 2838 acutely admitted medical patients with COPD as primary (AECOPD) or secondary diagnosis. Primary outcomes were 30- and 90-days all-cause mortality.

May 9, 2018

“Cumulative childhood risk is associated with a new measure of chronic inflammation in adulthood” published in Journal of Child Psychology and Psychiatry.

Line JH Rasmussen and co-workers from Duke University, USA, investigated the hypothesis that childhood exposure to risk factors for adult disease is associated with elevated suPAR in adulthood.They used 837 participants in the Dunedin 1972-1973 birth cohort and found that children who experienced more adverse childhood experiences, had lower IQ, or had poorer self-control showed elevated adult suPAR.

The authors conclude that suPAR is a useful addition to studies connecting childhood risk to adult inflammatory burden.

After a median 6.8-year follow-up, a total of 68 deaths (13.6%) were recorded. In a model incorporating suPAR, CAC, and hs-CRP, only suPAR was significantly associated with mortality (hazard ratio 2.66, 95% confidence interval 1.63-4.34). Addition of suPAR to a baseline clinical model significantly improved the C-statistic for all-cause death (Δ0.05, 95% confidence interval 0.01-0.10), whereas addition of CAC or hs-CRP did not.

March 16, 2018

“Effect of simvastatin and ezetimibe on suPAR levels and outcomes” published in Atherosclerosis.

suPAR is an inflammatory marker associated with cardiovascular disease. Statins lower both LDL-cholesterol and C-reactive protein (CRP) resulting in improved outcomes. However, whether lipid-lowering therapy also lowers suPAR levels is unknown. The study included 1838 patients with mild-moderate, asymptomatic aortic stenosis, to evaluate relationships between change in suPAR with all-cause mortality and the composite endpoint of major cardiovascular events (MCE) composed of ischemic cardiovascular events (ICE) and aortic valve related events (AVE).

The study concluded that Simvastatin and Ezetimibe treatment impeded the progression of the time-related increase in plasma suPAR levels.The change in suPAR was associated with all-cause mortality, MCE, and AVE.

February 1, 2018

suPAR is known to be a strong predictor of readmission and mortality in the acute care setting. In this study, it was investigated if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality. The study included 17,312 acute medical patients. The risk of acute surgery during follow-up as well as the 90-day post-operative mortality risk was modeled by Cox regression analyses adjusted for sex, age, C-reactive protein, and Charlson Comorbidity Index (Charlson Score).

The study concluded that elevated levels of suPAR in acutely admitted medical patients were independently associated with increased risk of future acute surgery as well as with 90-day post-operative mortality.

October 17, 2017

The study investigated the potential association between suPAR and incident comorbidity and all-cause mortality in a well-treated HIV-infected population.

The study showed that a high suPAR level at baseline was associated with increased risk for cardiovascular disease, chronic kidney disease, chronic lung disease, liver disease, and cancer, and all-cause mortality during follow-up.

September 2, 2016

"suPAR in acute care: A strong marker of disease presence and severity, readmission and mortality. A retrospective cohort study" was published online in EMJ, Emergency Medical Journal in September 2016.

The study included 4343 consecutively admitted patients from the AMU at a large Danish university hospital (Hvidovre).

The conclusion is again, that in an unselected population of acute medical patients;"A high suPAR level upon admission to the AMU is a marker of severe disease and increased risk of readmission and mortality after adjusting for all other risk factors .... and suPAR adds information to established prognostic indicators".

Patients with low suPAR levels have low risk of readmission and mortality, while patients with high suPAR levels have a high risk of adverse events.

November 10, 2015

A study in the New England Journal of Medicine published on November 5 shows that suPAR reliably can predict the development of Chronic Kidney Disease up to five years before symptoms of this disease emerge - a disease that affects an estimated 600 million people.

Currently, physicians rely on two markers to monitor existing kidney disease, but they are not sensitive enough to predict a persons risk of developing the disease or to catch it in its early stages.

The New England Journal of Medicine study found that a high suPAR level was an excellent predictor of future kidney disease."We can now stratify people according to their risk of developing kidney disease using suPAR levels" said Dr. Salim Hayek, first author of the study.

The study is even a significant breakthrough in preventive medicine. Also diabetes patients, of which about one-third develop Diabetic Kidney Disease, can now be helped."This will help risk-stratify patients with diabetes on their risk of future kidney disease" explains Jochen Reiser, senior author of the NEJM study.

Results are based upon research using the suPARnostic® products from ViroGates.